For nearly all mental health-care practitioners, the most satisfying
aspect of our practice is our clinical interaction with patients.
However, any practicing psychotherapist can attest to the frustrations
in dealing with the mountains of paperwork that are required by
various managed care payers and other regulatory entities. But
theses demands are not necessarily all bad. Clear and well written
treatment plans, progress notes, and homework planners can assist
patients' progress in treatment. It also gives clinicians a clearer
sense of their patients' progress and facilitates accountability.

An ideal solution to this problem would be a system that automates
much of the repetitive and laborious processes required in our
daily clinical practice. Therefore, an ideal computer software
system would be one that is simple to use, does not require a
steep learning curve, is flexible enough to accommodate our individual
clinical styles, intuitive to use, and, most importantly, can
easily and effortlessly be incorporated into our practice.

There are several computer programs that purport to help clinicians
in organizing the labyrinth of paperwork that is required. TheraScribe
4.0 is the latest offering from PEC Technologies. It comes in
three versions: 1) Solo / Small Group Edition - to install on
one computer, 2) Solo / Small Group Edition - for installation
on a Network of up to 10 Users, and 3) Enterprise SQL Edition
Server Installation with Enterprise SQL Edition-Client. According
to the company's literature, TheraScribe "is simply
the most robust, yet easiest-to-use, behavioral health clinical
management system available."

Strictly speaking, TheraScribe 4.0 is more than a simple
tool that organizes paperwork. What separates this program from
others is the "ability of the software to put the contents
of Wiley's best-selling Practice Planner books (Treatment Planners,
Homework Planners, and Progress Notes Planners) at user's fingertips…with
thousands of prewritten clinical management components and tools…with…clinically
sound language, and on-screen help to expertly guide you through
each stage of the treatment process: intake/assessment, treatment
planning, progress monitoring, and outcomes analysis."

The various features available in this program are too numerous
to mention in this review. However, as expected, essential features
like psychosocial assessment, billing authorization date (with
numbers of remaining visits available), DSM IV codes, ability
to input demographic information, mental status exam, and progress
notes are all included in this program and they function as advertised.

A significant aspect of this program is its flexibility and the
expandability via the use of various treatment and treatment-setting
modules. For example, TheraScribe 4.0 integrates Wiley's
Practice Planner books into the program, thus allowing clinicians
easy assess to their bundled treatment planners and homework planners.
Other treatment planner modules that can be purchased separately
from the vendor include addictions, adult psychotherapy, child
psychotherapy, family, group, and personality disorders. These
treatment modules can also be custom-tailored to various treatment
centers (e.g., adult criminal justice planner, behavioral medicine
planner, pastoral counseling treatment planner, and the psychiatric
evaluation and pharmacology planner). The same applies to the
different progress note planners; the add-on module for adult
progress notes planner, the adolescent progress notes planner,
the addiction progress notes planner, and the child progress notes
planner also can be purchased separately.

Another important feature of this software is the ability to customize
it. Adding fields and creating custom reports can be relatively
easily done, especially after getting familiar with the program.
Yet to this reviewer, that is the most important question regarding
migration to a computerized system in assisting with our clinical
practice: usability.

No matter how powerful the features are, it means very little
if the program is too difficult to understand and cumbersome to
use. There is an inherent flexibility in using pen and paper in
keeping records and creating a treatment plan. It allows for the
freedom to be flexible and creative, and paper allows the leeway
to use our clinical judgment without having to follow a rigid,
prescribed course of treatment.

Of course some of this flexibility can be introduced into TheraScribe
4.0 but not without having sufficient familiarity with the details
of the program. There is a substantial learning curve associated
with this program though TheraScribe 4.0 comes with a CD-ROM
based tutorial designed to help. The makers also offer telephone
and onsite training for additional fees.

TheraScribe 4.0 essentially delivers what it promises in
the promotional literature. The program interface is well designed,
and with some practice, is relatively intuitive to navigate throughout
the program (those who do not have much experience with using
computers may have more difficulty.)

In this reviewer's opinion, TheraScribe's biggest strength
is also its weakness. The programs' flexibility, power, and multitude
of features require a great deal of time, energy, and effort to
learn and understand. It requires a near-complete commitment to
the program on the clinicians' part. Therefore, the essential
question clinicians must ask when assessing the possibility of
migrating their clinical information/practice to a computerized
system such as TheraScribe is the degree of commitment
to change their present way of doing things. Halfhearted commitment
may be counterproductive as this may mean maintaining both handwritten
notes and the computerized system at the same time, thus doubling
the workload.

The TheraScribe 4.0 under review was a Demo disk with several
key features disabled, including printing. Given these limitations,
it was difficult to make a full commitment to switch more records
to this program. It was difficult, therefore, to adequately assess
the day-to-day practicality of using this system in clinical practice.

TheraScribe 4.0 is more than a simple record management
program. It is a set of various tools. As with any tool, in order
to use it effectively, it is important to understand how it is
used and the strengths and weakness of that tool. In this case,
TheraScribe 4.0 delivers what it purports. The ultimate
question is whether that is sufficient to change the tried and
true pen and paper method. This can only be answered by individual
needs of clinicians and organizations.

TheraScribe can be a tremendously powerful practice aid
but its real start-up costs must include a realistic calculation
of the time and effort and motivation required to truly commit
to optimal utilization.

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